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Drug rehabilitation is a term for medical and/or
psychological treatment of people who are dependent on
mind-altering substances such as alcohol, prescription
drugs (e.g., painkillers, sedatives), and street drugs (e.g.,
crack cocaine, heroin, or amphetamines). Amphetamines
are a class of very potent stimulants.
Drug rehabilitation programs (e.g., long term drug rehab)
are designed to teach a person ways to stop the abuse
so that its consequences can be avoided. These
consequences can be social (e.g., loss of friends,
divorce, estrangement from the family), legal (e.g.,
driving under the influence), financial (e.g., bankruptcy),
psychological (e.g., anger, depression), and/or physical
(e.g., weight loss, liver damage).
The above caption shows a traditional drug rehabilitation group run by a group facilitator.
Drug Rehabilitation
WHAT TYPES OF NON-MEDICATION TREATMENTS ARE
AVAILBLE FOR DRUG ADDICTION?
General Principles and Structures
The types of drug addiction treatments available are many and
varied. Most involve some form of counseling, either in individual
or group format (e.g., with family or work colleagues). The
counseling can be daily, weekly, or less frequently and it can be
done on an inpatient (residential treatment) basis such as an
inpatient rehab Texas facility, or an outpatient basis.
Family members can help convince addicts to get into treatment by refusing them any type of
assistance until they comply with treatment efforts. An initial meeting with a counselor may involve
motivational interviewing, which are techniques that use a direct approach to motivate a person to
change behaviors (e.g. by helping them think of a better future). Motivational incentives such as positive
reinforcement (e.g., verbal praise, tangible rewards) is often used to encourage drug abstinence.
Some people released from prison may be required to go to a recovery house (also known as an
addiction recovery home or sober house) in which the person is required to remain sober and comply
with the requirements of the program. People in recovery houses are required to pay for their own stay.
Behavioral Treatments
Behavioral models of drug rehabilitation use the principles of functional analysis of drinking behaviors.
This involves examining what is known as the motivating operation, which explains why a person wants
or does not want to do something and why they act or do not act in a particular moment. Functional
analysis of addiction also examines what triggers or precedes the addictive behavior and what the
consequences of the behavior are that continue to maintain it.
Twelve Step Programs:
Twelve Step Programs are very popular approaches to addiction treatment that have been shown to
predict abstinence success one year after treatment for alcoholism. Success rate of Twelve Step
Programs with people addicted to other illegal drugs depends on the drug (e.g., lowest for opiods). The
steps were first published in the book Alcoholics Anonymous in 1939 and are as follows:
1. We admitted we were powerless over alcohol—that our lives had become unmanageable.
2. Came to believe that a power greater than ourselves could restore us to sanity.
3. Made a decision to turn our will and our lives over to the care of God as we understood Him.
4. Made a searching and fearless moral inventory of ourselves.
5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
6. Were entirely ready to have God remove all these defects of character.
7. Humbly asked Him to remove our shortcomings.
8. Made a list of all persons we had harmed, and became willing to make amends to them all.
9. Made direct amends to such people wherever possible, except when to do so would injure them or
others.
10. Continued to take personal inventory, and when we were wrong, promptly admitted it.
11. Sought through prayer and meditation to improve our conscious contact with God as we understood
Him, praying only for knowledge of His will for us and the power to carry that out.
12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to
alcoholics, and to practice these principles in all our affairs.
Due to the emphasis on God, religion, and spirituality, Twelve Step Programs have come under
significant criticism. Mandated attendance in such programs has been challenged legally for people who
do not believe in the religious/spiritual element. Twelve Step Programs are popular with
people/practitioners who believe in the disease model of addiction, which holds that people are
powerless over their addiction due to it being a biological disease worsened by environmental factors.
Thus, use of external supports such as medication, belief in a higher power, and reliance on a social
support network are used as treatments for people with this belief system.
Due to the emphasis on God, religion, and spirituality, Twelve Step Programs have come under
significant criticism. Mandated attendance in such programs has been challenged legally for people who
do not believe in the religious/spiritual element. Twelve Step Programs are popular with
people/practitioners who believe in the disease model of addiction, which holds that people are
powerless over their addiction due to it being a biological disease worsened by environmental factors.
Thus, use of external supports such as medication, belief in a higher power, and reliance on a social
support network are used as treatments for people with this belief system.
Humanistic (Client Centered/Rogerian) Approach
This approach to counseling was popularized by psychologist, Carl Rogers. It relies on unconditional
positive regard for the client, empathy, and genuineness. This approach holds that applying these
aspects to patients will help overcome any difficult problem, including substance abuse. A modern
version of this approach is known as Client-Directed Outcome-Informed (CDOI) therapy. This has been
more recently referred to as the Partners for Change Outcome Management System (PCOMS).
Psychoanalysis
According to the psychoanalytic theory of addiction, popularized by psychologist, Sigmund Freud, use of
certain drugs facilitate an unconscious desire to fulfill specific fantasies and a way to avoid taking
responsibility for those fantasies. It is also considered to be a maladaptive way of coping with prior
traumatic experiences.
Family Counseling
Family counseling is typically an adjunct to individual counseling designed to reduce family dysfunction
that can contribute to addiction and/or to help family members learn how to help and properly respond to
an addict’s behaviors. This type of therapy is typically performed by a licensed family therapist who
specializes in addiction treatment.
WHAT TYPES OF MEDICAL/MEDICATION TREATMENTS ARE AVAILBLE FOR DRUG ADDICTION?
Mainstream Medical Treatments
The first type of medical intervention that addicts need is detoxification. In other words, the patient needs
to get the drugs cleared out of their bodies first before beginning a treatment program. This needs to be
managed medically because too fast of a withdrawal can cause serious health consequences, including
death, since the body has come to depend upon the addictive substance.
Not all forms of detoxification require medication but prescription drugs may be used to help with the
detoxification. For example, in maintenance therapy, short-term use of medications such as methadone,
buprenorphine (e.g., Subutex and Suboxone), levacetylmethadol (LAAM) are used to treat addictions to
opioids (e.g., heroin, morphine, and oxycodone) because these medications (being opioids themselves)
help treat the addictive cravings (they are longer acting but produce less euphoria) but have less of a
withdrawal effect. Opioids are pleasure producing molecules/substances.
Substitute medications such as methadone can also be abused which is why their use needs to be
closely monitored. They may be used for an indefinite period of time. A study by the Australian
government entitled, “National Evaluation of Pharmacotherapies for Opioid Dependence” found that a
significantly higher rate of abstinence in heroin users was achieved with LAAM than either methadone or
buprenorphine at three and six months.
Maintenance therapy helps opioid addicts reduce acts of crime (e.g., stealing, violent behavior), which
then prevents arrest and incarceration. It also helps them keep their jobs, reduces high-risk behaviors,
prevents them from developing certain diseases (e.g., hepatitis C, HIV) by reducing intravenous drug
injections, and also prevents deaths from violent crime and disease. Hepatitis is an infection of the liver
that causes liver inflammation. HIV (human immunodeficiency virus) is a virus that attacks the body’s
immune (defense) system, leading to infections and harmful tumors. Tumors are tissues that grow more
rapidly than normal.
Naltrexone is another type of drug used to treat opioid dependence because it works as a long acting
opioid receptor antagonist. In other words, it blocks the receptor that opioid molecules normally stimulate
to exert its pleasurable effect. This medication is usually prescribed in outpatient medical settings
although it may be initiated during inpatient detoxification. Naltrexone is also used to treat alcoholism
because it reduces the rewarding effects of alcohol and reduces the cravings for it.
A medication that has been used for a long time to treat alcoholism is disulfiram (commonly known as
Antabuse). This medication works by causing a person to feel very sick (e.g., nauseous, flushing,
palpitations) when consuming alcohol. This medication works best when patients are highly motivated.
Some alcoholics who use this medication only use it in situations that would place them at high risk for
consuming alcohol, rather than using it every day.
Another medication used to treat alcoholism is Acamprosate (Campral) which works by stabilizing a
chemical imbalance in the brain that would otherwise be disputed by alcoholism. Although this
medication has been shown to be helpful in treating patients with severe alcoholism and helping them
maintain abstinence for weeks or months, it can cause severe side effects and it works best when
combined with attending support groups.
Nitrous oxide (a type of gas used to reduce pain) has been used as an effective treatment for a number
of addictions. For example, it has been used to prevent cravings after withdrawal from alcohol, tobacco,
and marijuana. Some have proposed that the anti-convulsant medication, topiramate (Topamax) may be
a useful for treating alcoholism and cocaine dependence by reducing dopamine release. Dopamine is a
chemical messenger in the brain that facilitates addiction by providing pleasurable sensations in
response to substance use. The results of studies have been mixed, with some showing a positive
response on some outcome measures and others not. Lastly, some antidepressant medications have
also been used to treat drug use, especially nicotine. A good example of this is the medication bupropion
(Wellbutrin).
Non-Mainstream Medical Treatments
Some treatment providers have experimented with Ayahuasca as a way to treat addiction. Ayahuasca is
a medicinal plant mixture used by indigenous people in the Amazon River basin for healing purposes. It
is also known as the vine of the soul or the vine of death because it is actually quite dangerous and can
cause death. It is a combination of monoamine oxidase inhibitors (MAOI) and N,N-dimethyltryptamine
(DMT). MAOI’s are chemical that inhibit monoamine oxidase (MAO). MAO functions to inactive
neurotransmitters, which are chemical messengers in the brain. DMT is a mind altering substance often
found in plants that can alter consciousness.
Despite the risks, many people in the Amazon region use Ayahuasa for rituals and ceremonies and it
usually does not cause health problems or addictions in this context. Because of this, some people do
use Ayahuasca to treat addictions although the mechanism of action is unclear. One hypothesis is that
Ayahuasca reduces the level of dopamine (see above) in the brain. Reducing the level of dopamine in
the brain may interfere with the connections between nerve cells in the brain that help maintain
addiction.
Another theory is that Ayahuasca may exert psychological effects to treat addictions due to changes in
perceptions, emotions, thoughts, and behavior produced by the drug. It is believed that this may help
resolve traumas, improve decision making, and encourage the understanding of potential outcomes of
choices. Another theory is that Ayahuasca facilitates a transcendent (i.e., other-worldly) experience that
helps the person resolve the addiction. An example would be believing that one met a spirit who told the
person to stop abusing substances. Use of Ayahuasca for addiction treatment remains controversial
because it is considered an illegal controlled substance in some countries.
There are some programs that rely on alternative medicine approaches to treat drug addiction (such as
mega vitamin therapy) but the majority of medical experts do not believe that such programs have strong
scientific support. Such programs are sometimes lumped under the term “orthomolecular medicine.”
Another non-mainstream medical treatment for substance abuse is the drug Ibogaine. This type of drug
promotes hallucinations, which are strong sensory perception that one has of an object or event while
awake, when no such object or event exists. Although some fringe groups have promoted it as a way to
treat substance dependence and cravings with a broad range of drugs (e.g., alcohol, narcotics, nicotine,
stimulants) there has never been a controlled research study to show it is effective and no group of
physicians consider it an acceptable form of treatment. In fact, it is an illegal drug in the U.S. and use of
it has caused several deaths due to heart problems (e.g., rapid heart rate).
People who use Ibogaine tend to obtain it in countries outside the U.S. where there is little oversight
which can include motel rooms and actual rehabilitation centers. This is a good example of why people
need to thoroughly research substance abuse rehabilitation centers before committing to one. Most
people seek out Ibogaine to treat opioid withdrawal.
WHERE CAN I FIND SUBTANCE ABUSE TREATMENT RESOURCES?
The Substance Abuse and Mental Health Services Administration (SAMHSA) is an organization run by
the federal government that contains a searchable substance abuse treatment facility locator and other
treatment search options. Partners for Recovery is a SAMHSA program that is a collaboration of
communities and organizations mobilized to help individuals and families achieve and maintain recovery
and lead fulfilling lives. Information on medication assisted treatment can also be found on the SAMHSA
website.
For health care providers, the National Center on Substance Abuse and Child Welfare is a federal
program that provides information, expert consultation, training and technical assistance to substance
abuse treatment professionals to improve the safety, permanency, well-being and recovery outcomes for
children, parents, and families.For psychiatric professionals looking to work in a rehabilitation setting,
there are a few companies who currently specialize in psychiatry recruiting and this employment
assistance can be very useful especially if you are changing careers or planning a big move.
DO PEOPLE WITH DRUG ADDICTION HAVE CHEMICAL IMBALANCES?
Some, but not all people with drug addiction have chemical imbalances in their brain which can make
recovery more difficult.
WHICH DRUGS ARE THE MOST HARMFUL?
A 2010 study in the journal, Lancet, entitled "Drug harms in the UK: A multicriteria decision analysis" was
specifically designed to address this issue. There were various ways that harm was defined in the study.
This included death; drug-related illnesses, accidents, or other negative health effects; dependency;
impairment of mental functions; loss of tangible things; loss of relationships; injury to others; crime;
environmental damage, family breakdowns, international damage (e.g., international crime), economic
cost, and damage to the community.
When combining harm to others and harm to self the most harmful drug was alcohol. This was followed
by heroin, crack cocaine, methamphetamine, cocaine, tobacco, amphetamines, cannabis, GHB (gamma
hydroxybutyrate), benzodiazepines, ketamine, methadone, mephedrone, butane, qat/khat, anabolic
steroids, ecstacy, LSD (lysergic acid diethylamide) , buprenorphine, and mushrooms. Alcohol was the
drug most harmful to others, followed by heroin and crack cocaine. LSD and mushrooms were the least
harmful to others. The most harmful drugs to the self were heroin, crack cocaine, methamphetamine,
and alcohol. The least harmful drugs to users were LSD, buprenorphine, and mushrooms
DO DRUG OFFENSES ALWAYS RESULT IN A PRISON SENTENCE?
Possession and use of all illegal drugs can result in a prison sentence. Possession and use of legal
drugs (e.g., alcohol) can also result in jail time in certain circumstances (e.g., driving with a blood alcohol
level over the legal limit). The more significant the drug offense and/or the more one has been caught
with illegal drugs, the more likely it will result in prison time. Those convicted of more minor offenses
(e.g., drug possession, driving under the influence) can receive alternative sentencing, meaning that they
are required to attend inpatient substance abuse treatment instead of jail time. Some have been required
to attend Alcoholics Anonymous meetings or meetings for other Twelve Step Programs. However, some
have successfully mounted a legal challenge to this requirement on the grounds that it is inconsistent
with the Establishment Clause of the First Amendment of the U. S. Constitution, requiring separation of
church and state. This is because Twelve Step Programs involve belief in as higher power, which is often
interpreted as God.
WHAT ELSE IS DRUG REHABILITATION KNOWN AS?
Drug rehabilitation is also known as drug rehab, rehab, substance abuse rehab, and substance abuse
rehabilitation.
One of the most important things drug addicts must learn in rehabilitation is how to live
in a drug-free environment because they are not used to doing this. This is important to
preventing a relapse. For example, many addicts have friends and associates who are
also addicted to drugs. These individuals often tempt people to use drugs again who
are trying to overcome their addiction.
Some programs are designed for certain age ranges, certain genders, or certain types of addictions
such as meth withdrawal treatment. Some people attend local drug rehabilitation programs but others
are designed for people who want to be far away from their regular location. Some counseling is
designed for when the patient is in a crisis and needs support, which is known as crisis counseling.
The goal of addiction counseling is to help identify the behaviors and problems related to the addiction,
develop insight into the fact that a problem is actually present, change the behaviors to healthy ones,
develop proper coping strategies, and control the addiction. In what is known as an “intervention,” a
family requests help from a counselor to get the addict into treatment. Research has shown for decades
that effective addiction programs help treat the multiple needs of the patient rather than only the
addiction. However, the most important component of treatment success is motivation of the patient.
Programs based on this model use problem-solving techniques to help the addict overcome addiction
and employs systems to re-inforce abstinence (e.g., participation a non-drinking club). Addiction
treatments that are based on this type of behavioral approach exist for the substance abuser (known as
the community reinforcement approach) and the family (known as community reinforcement and family
training or CRAFT). This helps families feel empowered to help with treatment. The system also
includes a program to prevent domestic violence. Both of these approaches have been proven to be
effective via published research (about a 70% success rate).
Some counseling programs involve a sobriety coach, which is a role model who is sober that the
person with addiction can go to when struggling with various issues such as maintaining sobriety. The
goal of the sobriety coach is to help the person to maintain sobriety and to maintain healthy daily
routines outside of any treatment facilities. There is also preventative counseling which involves
educating the public about drug addiction to prevent it from occurring.
After drug detoxification (see below) and medication treatment (when applicable) the National Institute
on Drug Abuse recommends detoxification followed by behavioral therapy and attempts to prevent
relapse. The latter may involve relying on support systems in the community or family.
Cognitive Behavioral Therapy (CBT)
CBT is based on the notion that our thoughts are what cause us to feel the way we do and that by
modifying your thoughts that you will be able to change your feelings and behaviors. Some of the
beliefs addicts have are negative and automatic, such as “I must be a bad person” or “No one really
loves me.” CBT theory holds that beliefs such as these cause one to believe that the effects of using a
substance will make them feel better emotionally. This leads to cravings and permissive belief systems
to form that facilitate the craving (e.g., “One more isn’t going to hurt.”). These permissive beliefs lead
the person to seek and use drugs.
A CBT counselor would try to help the patient understand that beliefs such as these are harmful and
how to change them. Home-work assignments and behavioral exercises (e.g., role-playing) help
reinforce what was learned in counseling and help the person recognize, avoid, and change negative
thoughts that can lead to relapse.
A form of CBT, known as Acceptance and Commitment Therapy (ACT) emphasizes mindfulness
(paying attention and being aware) of negative emotions that people react to by using substances (e.g.,
someone who is stressed goes to smoke a cigarette). The goal is that developing such mindfulness
helps prevent maladaptive and impulsive/compulsive responses they have developed to deal with
them. Research has shown that ACT is effective in treating suubstance abuse.
Relapse Prevention is a popular CBT approach developed by Alan Marlatt. He describes four
psychosocial processes important to relapse prevention: 1) Self-efficacy: the ability to competently and
effectively deal with high risk situations (e.g., being at a party where there are alcohol and drugs) that
can produce a relapse, 2) Attributions of causality (beliefs in the cause of relapses): relapses are more
common when people have certain beliefs about internal causes of addiction and are placed in unusual
situations (e.g., “I’ll just have one drink at this party), 3) Outcome expectancies: a person’s expectations
about the effects of a substance, and 4) Decision-making processes: the multiple decisions people
make lead to addiction and relapse.
Although some decisions may seem apparently irrelevant leading up to a relapse, they can actually
play an important role in leading to a relapse. An example would be a decision to go out with a friend to
socialize but the friend later takes the person to a restaurant where alcohol is served. The person will
need to use successful coping strategies, such as not even looking at the drink menu or distracting
him/herself by admiring the décor to avoid the relapse risk. The more successful one becomes in such
situations, the more successful they are in remaining abstinent in the future.
If the person does not use proper coping resources, rumination on cravings can begin, he/she may
experience a relapse due to low self-efficacy and expectations for positive outcomes. When something
like this happens, it is referred by Marlatt as an Abstinence Violation Effect. This is characterized by
guilt for getting intoxicated again and low self efficacy for future abstinence in similar tempting
situations. Marlatt states that this is a dangerous path to a full relapse.
